Tips for successful outcomes for descending thoracic and thoracoabdominal aortic aneurysm procedures.

The continuing evolution of endovascular approaches to the repair of descending thoracic and thoracoabdominal aortic aneurysms necessitates careful evaluation of the safety and efficacy of these alternative therapies as they compare to the "gold standard" of open surgical repair. The purpose of this report is to present our approach to conventional open surgical repair of these aneurysms. Routine surgical modalities include use of moderate systemic heparinization, mild permissive hypothermia, and sequential aortic clamping. For extensive thoracoabdominal and select descending aortic procedures, additional modalities are used. The multimodal approach to organ protection during surgical treatment of descending thoracic and thoracoabdominal aneurysms has evolved substantially over the past 20 years. Experienced surgical centers now have much lower mortality and morbidity rates for these operations than previously reported. Current management strategies enable patients to undergo conventional open aneurysm repairs with excellent early survival and acceptable morbidity.